Tumor Necrosis Factor alpha (TNFa) plays a central role in the pathophysiology of several human disorders, and anti-TNFa agents (e.g., adalimumab, etanercept, and infliximab) have clinically validated therapeutic utility in the treatment of autoimmune and inflammatory disorders, such as rheumatoid arthritis, psoriasis and inflammatory bowel disease. Despite their success in the clinic, anti-TNFa biologics are still limited in the maximal efficacy they can achieve in patients, necessitating the identification and development of more potent and effective therapeutics. Patients treated with anti-TNFa biologics may also develop an immunogenic response to the therapeutic thus limiting its effectiveness. Therefore anti-TNFa therapies with lower immunogenicity and high efficacy would be useful for further controlling disease.
Synthetic glucocorticoid receptor agonists (e.g., dexamethasone, prednisolone, and budesonide) are a potent class of small molecules used in the treatment of inflammatory disorders, but their utility in the chronic treatment of disease is limited due to severe side effects. Several approaches to retain the anti-inflammatory efficacy of synthetic glucocorticoids while sparing the unwanted toxicities have been described (Rosen, J and Miner, J N Endocrine Reviews 26: 452-64 (2005)). However these methodologies have met with little success. There is a need in the field of autoimmune and inflammatory disease therapeutics to develop therapeutics with enhanced efficacy and longer duration of action compared to anti-TNF antibodies and with minimal unwanted effects.